0000904454-12-000331.txt : 20120621 0000904454-12-000331.hdr.sgml : 20120621 20120621110707 ACCESSION NUMBER: 0000904454-12-000331 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120615 FILED AS OF DATE: 20120621 DATE AS OF CHANGE: 20120621 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TRAYNOR SEAN CENTRAL INDEX KEY: 0001212999 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 12918786 MAIL ADDRESS: STREET 1: 320 PARK AVENUE STE 2500 CITY: NEW YORK STATE: NY ZIP: 10022 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: AMERISAFE INC CENTRAL INDEX KEY: 0001018979 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 752069407 STATE OF INCORPORATION: TX FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 BUSINESS PHONE: 337-463-9052 MAIL ADDRESS: STREET 1: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 4 1 edgar.xml PRIMARY DOCUMENT X0305 4 2012-06-15 0001018979 AMERISAFE INC AMSF 0001212999 TRAYNOR SEAN C/O WELSH, CARSON, ANDERSON & STOWE 320 PARK AVENUE, SUITE 2500 NEW YORK NY 10022 1 0 0 0 Common Stock 2012-06-15 4 A 0 1119 0 A 5142 D Restricted stock award issued under the Issuer's 2010 Restated Non-Employee Director Restricted Stock Plan. Such shares will vest at the time of the Issuer's 2013 annual meeting of shareholders. Share number reflects the correction of two shares previously over-reported. David Mintz, Attorney-in-Fact 2012-06-19